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   He who fights with monsters should be careful lest he gaze long into the abyss... only to find his own reflection.

Cape Cod Healthcare Center for Behavioral Health, Hyannis, Mass., March 2010

Introduction

My journal from the Cape Psych Center, Cape Cod Healthcare Center for Behavioral Health, Hyannis, Mass., March 2010.

Again, I do not exactly remember the circumstances of how I arrived here — but I think I asked someone to bring me to the Falmouth Hospital Emergency Room.

While transcribing this I noticed the places where I was cynical, stubborn and just plain dumb. But that is the point of all this writing: to understand, to learn, to figure things out, to grow, to get better.

I hate the after taste of vitamins in the morning.

Day One

Arrival

The clock is designed wrong.

Back to inpatient again.

This was the easiest transition of them all, and the shortest. Not a single hassle with anyone -- the nurses at Falmouth Hospital are the best! -- no hundreds of questions by nurses or doctors.

Arrival was at night so the halls are all nearly empty and quiet. The place is clean, warm and small -- and a Psych unit, not a Dual Diag!

The typical stay here is 3 to 5 days.

I hope to remember to ask if the doctor can get copies of my blood and urine analyses and to go over them with me.

Day Two

Dr-N saw me this morning. It was uneventful. Just a typical, "What brought you here?" I explained it well enough. He explained the blood work looked good -- the last check is for the liver. (So I did not ask to "go over..." but he did offer a satisfactory amount of data.)

("Don't shake my fucking hand, dude," went through my head.)

First Group

After introductions... "Tell us about yourself."

"I drink and stuff," I said. They did not get it. P-D: "He, he, he. I'm Dave and I like to party."

I do not like this group of patients, and it may not be possible -- the unit is so small -- to find a quiet, secluded place to hang out. Only crap on the TV and the crap is loud and annoying. Great.

From the group room I go to the dining room where it is now empty. I sit strategically. But it is only a moment before two talking people come in, followed by a nurse. I go back to my room. P-R [my room mate] is sleeping.

The nurse came by and wanted to talk. "Fine, of course," I said. She started off with if still had thoughts of suicide. "It's not on the forefront of my mind," I said. We talked about a recovery plan, mentioning a 12-step program. Ah... I told her I was sober for six years, meetings every day, a home group, a sponsor...

And then somewhere in the conversation she says, "Sometimes going off of alcohol causes anxiety."

I cringe inside and look down at nothing, dazed. There it is again like a stab in the back: "So, your drinking is causing your anxiety," with the last time [I heard that] still fresh in my mind.

Instead of looking back up at her and saying, "You've got to be fucking kidding me," I say, "I've had anxiety since before I ever had a drink."

It seemed to satisfy her but there was still doubt in her voice. I forget most of what was said, still reeling from that "You're just an alcoholic and need to go to meetings" demon.

I think she gets [it] though, and I must admit it and accept it, that just medication alone will not work. There needs to be AA meetings in my plan. A Plan Nine or something.

~

The food is "hospital food."

There is a woman who makes a point to stop and say "Hello," and to sometimes chat. She's cute, really cute. But crazy like me, so what's good with that?

~

Room mate has obsessive/compulsive tendencies: bed made impeccably as if he is no longer going to be sleeping in it, brushes and grooms incessantly -- scrubbing, scrubbing, scrubbing. He took my toiletries that were in a bag in the bathroom. When I first came in last night [and assigned a bed] the other bed looked like it had never been slept in and I assumed no occupant, and so I left the bag on the back of the sink.

The morning after breakfast the bag was gone and I noticed he was here. Quiet, polite, asks if I'm cold, too hot?, want the lights on?, some water?

At least he's not the type to chat about things.

~

I still feel like crap. Anxious, bored, annoyed (with myself and state of mind mostly), and worried. I expect a battle with the Dr. over my meds. Fuck.

Why am I here? Why am I scared? The thoughts creep over me like a cold sweat. Fear grips me and I feel like I must be mad! As I write this the madness fades but the fear remains.

The fear always remains.

[The page is inexplicably cut at this point. The next page continues mid paragraph.]

Like a puppy, after the slightest of hesitation, I said yes and got up and followed her to the group room. She had leaned in the doorway and asked if I wanted to watch TV. Like I said, she is cute, really cute. It was a joy watching her hang her body all about the chair, stretching, turning, on her back as she was talking to someone behind, occasionally standing to sing a phrase out loud to what was on VH1... it was cute.

Day Three

Room mate is scrubbing his teeth again, etc.

Why can't I see the light? The end of the pain? The end to the [anxiety]. The end to the pain? Why is this my life? It is not supposed to be like this and how can anyone live like this -- be expected to live like this?

Fear and pain oozes from my heart and affects the rest of my body like a cancer eating away at my muscle and bone, weakening me. A putrid, corrosive blackness enters my mind distorting my thinking.

I want release.

When I let my mind wander into the fear a face emerges from darkness. An indiscernible face -- a miserable constantly changing face -- it's features a blur. It's got a body. It stands alone in darkness. It is a human shape not quite clear in size and weight.

As I try to focus on it it's face changes -- from one ill-defined face to another, each one less human like and for frightening. A demon. A monster. Out of the ancient past. It's intent is harm -- selfish, callous harm. Uncaring of all but itself. Of it's own cruel gratification -- the taking from others. It satisfies itself of the flesh and will of others.

Yet, close to it as I am now it has no face. No face but a blob mass with pinpoints for eyes, a round bulbous nose, a drooping mouth with nothing but a blackness deeper than the surrounding darkness inside.

A despicable, slobbering hiss is all that can be heard from it. It's arms are like two arms with fish hooks for fingers. My mind screams to stop--

~

I do not understand the idea of "call someone" when you are feeling suicidal, despair, etc. If I call you, what are you going to say? "It'll be all right." "Everything is going to work out." "People love you." And if I do talk to you, tell you of my woes... And even if you can convince me of my worth, what about hours from now?The next day? And the day after that? Can I call you every day?

~

Don't these people know... wait a minute. Of course they don't, or if they do they think it can be "over come."

For me, saying something "about myself" -- especially to a group of first time seen strangers -- is a kind of agony that invokes fear and panic. ("Come on G., let's go to the anxiety invoking group.")

So, I, not wanting to say anything at all, said (hoping someone would get the reference), "I drink and stuff."

The nurse did catch on a bit I recall now. For she added, "Class clown," with a bit of a laugh. I don't know if she was just being funny or meant it sarcastically of me or him. I hope one of the latter.

~

Here comes the foot scuffler. I swear he's got sandpaper on the soles of his shoes.

~

Sometimes telling someone how you feel in a place like this is the wrong thing to do -- a case of pointless self validation by the asker.

"How are you feeling?"

"Terrible."

"Oh?"

"Despairing, hopeless..."

Such conversation can only end in the asker saying, "Well, be sure to tell your doctor and go to groups." A useless endeavour.

(Later she had me do a "Becks Inventory" [which I forget what it is/was])

~

Just met with "Joe", the weekend Social Worker. Why to they insist on doing things the hard way! Yet another Staff interviews me, going over my "history" and makes yet another "report" and judgement! And he's just the weekend guy!

"Well," hey says at the end. "I've got to get Dr-N's report and I'll make my report, and hopefully mine will be a supplemental covering some things he did not ask."

And he wanted to call my sister and "make sure she's OK with everything." Like, "Not that I don't believe you." But really, you don't believe me Mr. weekend SW.

~

"So, what do you do?" the nurse asked me with a smile but in a nearly shrill voice twinged with the edge of a miniature drill sergeant. "What do you do before the meds run out? Two days before, three days before? What do you do"

She had just come on shift this weekend night nurse and read in my file that I "relapsed" and had "stopped" my medications.

She began saying all this in her sweet and sour little shrill voice after I corrected her by saying that I "ran out" of medications.

"What do you do?" she hammered away. I was wanting to tell her off but then simply played the game. "You call your doctors," was what I replied. Of course.

Of course, I explained what actually happened, but she simply threw more "What do you do?"s at me.

"Breathing exercises," I started. "Going for a walk. Call friends and family." and I listed several of the "standard" things "you do."

"Do you go to meetings?" she asked.

"No..." I started.

"So you don't want to go to meetings." She was making notes all the time.

"It is not that I do not want to go to meetings. It's just that my fears and lack of will prevent me from going."

But it was no use.

I was all so simple, you see, I just need to "call AA," instead...

Call AA. Yeah right. Scared of my own reflection -- did I tell you about that? -- afraid of the phone for so long, afraid of strangers, and I just need to call AA and I'll be fine.

Yeah, right.

Day Four

I regret committing myself this time -- but that fucking Dr-G was such a prick and I let him bother me so much that I let go of reason and became so emotional. I got lost, stuck in "That place." That state of mind where I feel helpless, hopeless and useless. That core feeling of being exposed and vulnerable, and all I wanted to do was get away.

A component of the feeling is anger -- at that arrogant prick who was so disrespectful and full of his "board certified" self -- that too I wanted to get away from.

Anger. A killer emotion.

~

"Oh, I see that [the night nurse] wrote," the morning nurse was saying, "that both you and your doctor made mistakes in your medications?"

Shit. These people do not coordinate except by margin notes in my file? There is not an admittance sheet of some kind where all my previous "testimony" to what led me here was detailed?

So each doctor, each social worker, each nurse (morning, afternoon, night, weekend) all have differing understandings of my case.

Great. Just fucking great.

~

I have the right to refuse treatment and to seek alternatives. This is part of any hospital's "Patient Rights". I told the nurse that I know this and that I would work with them if I did not want to take my medication. She seemed pleased that I mentioned this.

"Yes, that's right," she acknowledged.

It was only an hour ago when she came by my room and asked me if I was taking all my medications, for a Klonopin and a Clonidine were found at the end of the hallway. At that time I told her, "I want to take them. I need to take them."

"OK," she said. "I just had to ask.

Don't these people, as I asked before, coordinate and communicate? I came here because I had run out of my medication.

Day Five

"G. You gonna get up?"

So called out my room mate early this morning after he had noisily got up, used the bathroom -- toilet, sink, cough, spit, scrub, rinse, towel, towel, opened the curtains, dug noisily through some paper bags and shuffled stuff around.

"WTF dude," I wanted to say. I ignored him.

~

You know what is really fucked? The nurses all do not want to hear a patient say anything other than "good" (or "fine" or "well" etc.) to the question of, "How are you?"

If I tell the truth, "terrible" for example, they, um, "think there is something wrong with me". [in that I am not "cooperating" with them and their work, going to groups, working on my plan, etc.] And if I say "good" they are just fine with that and walk away with a smile.

~

My room mate doesn't even close the door to the bathroom when he pisses now -- and then he... Aw, fuck, I hate how I get sucked into people's heads like this. It is like there is a fish hook in my brain and it's attached to the form in the bathroom -- the noises, the pulling of towels, the scrubbing, the wiping, the pulling of more towels -- WTF! Get it out of my head!

Shit.

~

It's about two o'clock now. The "group" is a movie -- obscure and never heard of -- and I left after a while. Before I did though the SW came in the room as if looking for someone. Would it be me? I am scheduled to see both him and the Dr. No. Not me.

I felt then my fear rise sharply -- heart palpitating, corrosion oozing from chest outward -- the beginning of panic. Why? Anticipation of seeing the Dr? The SW? Certainly that had something to do with it; but there was no preceding ideation of of seeing them, no projection of what would happen, just the thought.

And I lie here in my room, trying to read "The Fountainhead," and still my heart pounds and chest aches -- an ill-wind kind of feeling that something traumatic is going to happen.

It's that "Unknown Fear" again. It's a panic attack. Mild, but for certain. Double fuck.

~

Saw Dr-N for five minutes. "I don't have my notes but I understand..." He has a good memory although all we went over was my most recent hospital stays and number of siblings and simple shit like that.

He did, first thing though, ask, "How are things?"

"Well," I told him. "I am better than when I first came. Although for about almost an hour now I've been having a mild panic attack -- heart racing and quite anxious. I do not know what the trigger was." All during this time with him he kept nodding and smiling and taking notes.

He asked about suicidal thoughts and I said no, and I always get a little embarrassed a little afterwards. I don't know about the future, I added. I just hope things get better.

Then we talk of meds and my hear beats faster -- this interview is perhaps the cause of the anxiety.

"I've kept you on what you were on [from Beth Israel Deaconess] and I think we should go up." I breathed a sigh of relief then. "On the Effexor, 150, 175..."

"And on the Risperidone and the Klonopin too," I said with crossed fingers.

"I" (or did he use "We"?), "want to go one at a time to watch for side effects."

So, up on the Effexor next morning and "I'll see you tomorrow."

Fuck. That means at least 2-3 more days here.

He did though move me from "checks" to "routine" observations.

I am still panicky though. See how anxiety just cuts right through the meds?

~

It's late. I've taken a shower. Been reading. Anxiety is down to a manageable level now.

Shoot. I need to bring this up with the doctor: What am I to do about panic attacks?

~

It disgusts me how, when a patient goes to the nurse's station, obviously wanting something, but does not want to interrupt the staff who are usually busy at a computer or with paperwork, and who then stands there quietly, but is obviously noticed by someone, and is entirely ignored. Minutes will go by until someone will ask, sometimes barely looking up, "Do you want something?"

Day Six

I have little red spots all over my abdomen and back. They itch. Noticed last night about 8:30 after showering.

~

Let us see if right before I see the doctor/SW whether or not I get panicky.

~

Here it comes, the heart pounding, the fear-pain oozing -- why? My mind had been uncontrollably projecting. Not quite racing but imagining scenarios when I get out. The phone this morning -- a wireless -- did not work; it was not charged. And I'm like, "it figures," to myself. Then my mind starts it's projecting.

There is also a loud, intrusive conversation between a nurse and patient across the hall that is annoying.

Are all these things contributing to my anxiety? Just one? Something else?

I hope that in writing this I will calm down. But it does not seem like it. I have not had my morning meds yet. I shall seek them out now and come back to this--

Well, the nurse is busy so I have to skip/delay this part of the experiment -- and that phone call.

At 8:45 I got my meds, got my BP tested: 117/74 (it was an "alarmingly low" 84/64 this morning in bed). Then there was coffee. I got some. It's now 9:00 and group is supposed to start. I wait. The guy says when I ask, "we're having coffee, so about, ah, 9:20, so just chill out and..."

So, I'm back in my room writing this and my anxiety in actually coming down somewhat.

Sheesh.

~

I think of seeing the doctor today -- yes, my anxiety is somewhat, indirectly I should say, proportional to my thoughts of how things will go today.

My heart pounds, the fear-pain oozes still.

~

My anxiety had slowly dropped away, almost unknowingly. And the doctor comes and wants to see me. It went well. My anxiety did not jump until it cam time to discuss dosages. He upped the Effexor and asked if there were any side effects. No. And then I asked about increasing the Risperidone and Klonopin.

"We want to go one at a time. We want to see how the Effexor goes for one week first." And of the Risperidone he said increasing it may cause -- in his words exactly -- "side effects that could be be like worsening of depression." Which is quite the opposite of Dr GABA who said, quite readily, "doubling the Risperidone is fine."

He also said no to the upping Klonopin, stating the old (and tired) "It works on the same GABA receptors as alcohol," hinting that it will interfere with my body fully recovering from the effects of alcohol -- still he's treating me as simply an alcoholic.

"But it (the Klonopin) is a low dose (.5mg) and we could take you off it if you want." (I had said eventually going off it once, as to indicate that I understand the long term effects of benzodiazepine use.)

"No," I said. "I still need help with my anxiety."

He followed up with words to the effect of, "yes, of course," or something like that.

Sigh.

But he did mention being discharged tomorrow or the next day.

Whew.

Day Seven

I woke up with a very bad and very itchy rash all over my body. They did not give me my morning meds and sent me to the ER.

At the ER they took a look, blood and urine samples. They had no clue as to the cause of the rash other than an assumption ("Looks like classic medication allergy.") of a reaction to one of the meds. Since the only thing new [to me] is the Risperidone as an M-TAB they naturally suspect that.

They gave me via IV Benadryl and Pepcid (Famotidine). By the next day the rash was gone.

My room mate went on and on about it being something to do with what they clean the beds with. He even took his bedding off and wiped down his mattress (they were really thin and covered with blue plastic). Weird.

~

"God bless those who understand and respect."
"Love me for who I am, not for who you want me to be."
"Do I hate life or does life hate me? Think about it?"
"Chill'n like a villain."

~

We have quite the crew here now. P-S tried to jump the fence. P-L likes to crudely insult the Staff. P-D has pants over hospital blues which ride lower than his ass and he's got a book stuck in them. Some real huge guy just punched the wall a couple of times -- obviously hurting himself with the last one.

P-D once pulled from a bag a wrapped bundle of toilet paper and gave it to P-S. "This is for you, dude," or something, grinning wildly. P-S unwrapped it to find nothing inside.

P-D also pulled out what looked like a tube of toothpaste, handed it to P-S who sniffed it and handed it back. "What is that?" someone asked. "A blunt wrapper," P-D said.

[The diary abruptly ends here.]

Notes
  1. I had the idea why the clock was designed wrong in my head distinctly, I remember that precisely. However, I forget it now. I left the line in because that is how I record these diaries: exactly as written except where grammar is wrong.
  2. I did have a "suicide" attempt of sorts that got me sectioned in this unit (that I will write about at some point), but that was not this time as I wrote that I "committed myself" later on here so I am a little confused...
  3. Yeah, I left out who "him" was in that paragraph.
  4. When dispensing medications the nurse hands them to you in a little paper cup with a little cup of water and they watch you take them. They do not just pass them out like candy. That incident was fucked up.
  5. And I went into "that state" where I relapse — which I need to write about.
  6. As I post these pages, I realize: "Why the fuck am I on Risperidone?" That is for schizophrenia and bipolar disorder. It will not help me — miscommunication between doctor and patient! It's the Klonopin that I want.
  7. "Checks" is someone looking in on you every fifteen minutes; "routine" is whatever the hospital's routine is.
  8. My statement is not correct here. The "standard reasoning" for not giving benzos to an alcoholic is that they will increase alcohol cravings (or even make the alcoholic "high"). Not so in my case. But no doctor would ever believe that.
  9. Which does not jive with the "Effexor for one week first" statement.
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Writing Down the Pain
I'd like just once to fall asleep feeling good about myself. Just once. Drunken stupors do not count.